JAMA

Malpractice: A new legal standard for medical negligence

February 28, 2025

American Law Institute’s new standard shifts away from strictly relying on “customary practice” to patient-centric “reasonable medical care”, which factors in competency-based standards, evidence-based medicine, and physician-patient communication.

Definition: “The standard of reasonable medical care is the care, skill, and knowledge regarded as competent among similar medical providers in the same or similar circumstances.”

Individual states, which use differing legal standards, may adopt American Law Institute recommendations to varying degrees at different times.

Reasonable medical care

• The new standard still includes components of prevailing medical practice, yet conveys that juries mayoverride “customary practices” if these fall short of modern standards.
• The competency-based standard doesn’t require above-average (or even average) care—physicians with less than median skill may be considered competent and qualified.
• Evidence-based practice guidelines are embraced; however, questions about the variability in the quality of these practice guidelines are left open.
• Recommendations on physician-patient communication, including informed consent, are included in the statement.

The role of scientific evidence

Prevailing medical practice isn’t always aligned with best scientific evidence. Many approaches learned during medical school and training have evolved over time in the light of new evidence. Examples:

• Cardiac stents may be nonsuperior to medical management for stable coronary artery disease.
• Low-dose aspirin for cardiac arrest prevention may be harmful for many patients.
• Older adults are often prescribed Beers List medications that may pose increased risk for harm.
• Some cancer therapies don’t serve patient preferences and interests.
• Opioids pose far greater risk than typically believed two decades ago.

Source:

Aaron DG, et al. (2025, February 26). JAMA. A New Legal Standard for Medical Malpractice. https://pubmed.ncbi.nlm.nih.gov/40009364/